The fourth generation in bone repair.
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Biomedical subjects
Publications and source records attributed to M B Habal.
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Bone regeneration by distraction has become an accepted method for correction of congenital and acquired deformities. Unifocal bone generation is discussed as a technical note to demonstrate its feasibility in craniofacial surgery. The technique is simplified by the reorientation of the apparatus used, and the distraction is performed over a period of time to achieve a balance in the facial skeleton. Orthodontic elastics are used to balance the occlusion.
The use of bone grafts is the basis of all craniofacial surgery. Bone grafts are used to stabilize the open segments, expand the patient's structural boundaries, and fill defects created by trauma or congenital malformations. Bone grafts are harvested from local or distant sites as indicated. Biomaterial implants are used as bone substitutes when it is not possible to use bone grafts.
Cranial bone graft was used to reconstruct an orbital defect after resection. The repair was done so that the patient did not experience any deformity after the orbital resection.
Bone graft surgery is the basis of all craniofacial surgery. The use of bone grafts in the craniofacial region has changed from a basic trial-and-error concept of surgical triumph to the understanding of the fundamental concepts of bone healing and bone physiology. The search for the super graft continues, and may become a reality before the end of the millennium.
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Brånemark osseointegrated implants were used in combination with a cranial bone graft that was harvested from the outer table of the skull in a patient with a discontinuity defect of the anterior aspect of the mandible. First, a staged procedure allowed reconstruction of the defect. The second stage was placement of the Brånemark osseointegrated implant fixtures, followed by contouring the interior genial area by adding more bone grafts. The initial stabilization was done with an adoption plate that was used to stabilize the mandibular fragments during the healing phase. This plate was subsequently removed when the osseointegrated implants were placed. The patient had a full course of oral rehabilitation and a satisfactory final outcome.
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Occipital encephaloceles are commonly seen birth defects. The incidence is 1 in every 10,000 live births. These defects represent about 15% of the total birth defects reported and treated in the United States. The birth defects encountered today comprise over 50% of all pediatric admissions to general hospitals. Six patients with occipital encephaloceles are treated by a combined craniofacial approach. The corrective measure allows reduction of the herniated encephalocele and correction of the craniofacial deformity in the same operation procedure.
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Discourse features of 10 mothers of language-normal preschool children with repaired cleft palates were examined. Mothers had been provided training in infant stimulation. Fifty-six percent of the communication initiations within the mother-child dyads were made by the mothers. That level of responsibility for continuity of communication resembles the percentage of discourse initiation reported for mothers of language-normal children without orofacial clefts. All categories of utterance types were used by the subjects; a predominance was found among attention-getters and indirect directives. Distribution of discourse features appears to differ from that reported for mothers of both language-normal and language-impaired children who do not have orofacial clefts.
A simple technique is presented for quick harvesting of cranial bone in patients who require limited amounts of bone to cover defects in the craniofacial area. The major principle involved is to stay within the same anatomical region. For bigger defects, larger incisions and different techniques are usually used.
Bone grafting is one of the most common operative procedures in craniofacial surgery today. Almost all surgical defects have to be closed with a graft, and all stabilized segments require bone grafts for stabilization prior to fixation. In certain circumstances, however, lack of availability of large grafts necessitates the use of bone substitutes. In the patient presented, a large defect--which is larger than a critical size defect--did not close on its own, even though neonates have a very high potential for forming bone around the dura. The defect was closed with demineralized bone implantation and showed complete filling of the defect through the bone induction principle.
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